Comparison of the effects of cefixime and azithromycin on children's dysentery

Dissertation:

Dissertation to receive a specialized doctorate degree in pediatrics

Persian abstract

Title: Comparison of the effects of cefixime and azithromycin on pediatric dysentery

Introduction: Diarrhea is defined as passing watery stool more than or equal to 3 times during 24 hours. Infectious diarrhea is diarrhea caused by an infectious microorganism, of which Shigella is known to be the most important causative agent. Shigellosis in children may be associated with high morbidity and even death. Therefore, it is very important for the medical community to look for an alternative drug that is effective and efficient in the treatment of children with severe shigellosis.

Methodology: In this double-blind intervention study, 116 children aged 6 months to 12 years referred to the pediatric clinic of Amirkabir Hospital, who were diagnosed with dysentery by a pediatrician, were included in the study and were randomly divided into two equal groups. The first group received azithromycin for five days, the amount of which was 12 mg/kg on the first day and 6 mg/kg on the other four days. The second group also received cefixime at the rate of 8 mg/kg daily. Patients were evaluated for improvement of symptoms during 14 days. The information obtained for each patient was entered separately in the information form and analyzed by SPSS 17 software.

Findings: The results of our study showed that according to the P value, there was no statistically significant difference between the two groups in terms of age and sex and the number of children in the family. Two groups were not observed.

Discussion and conclusion: In general, the results of our study showed that the effect of cefixime in the treatment of children with dysentery was more and better than azithromycin, and with the correct treatment in patients, the additional cost imposed on the patient by incorrect treatment and also the antibiotic resistances that arise after incorrect treatments are reduced.

Key words: cefixime, azithromycin, dysentery, children

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-1- statement of the problem

The World Health Organization defines diarrhea as passing watery stool (which takes the shape of a container) more or equal to three times during defines 24 hours (1).

Infectious diarrhea is defined as diarrhea caused by an infectious microorganism. Infectious diarrhea is more common in developing countries than in developed countries (2). Its attack rate in developing countries is 6 to 12 episodes per child per year (3).

Many infectious microorganisms cause diarrhea. Escherichia coli, salmonella, shigella, yersinia and vibriocholera are among the important bacterial pathogens that cause diarrhea (4).

Dysentery is simply defined as diarrhea containing blood. Although many organisms can cause dysentery, Shigella is known to be the most important causative agent. Among the four Shigella serogroups, Shigella dysentery type 1 has the highest virulence and is the only factor that causes epidemic dysentery (5). Shigellosis in children may be associated with high morbidity and even death (7). The resistance of Shigella to trimethoprim sulfamethoxazole and ampicillin, which are the usual treatments used in shigellosis, is increasing worldwide (8). Resistance to nalidixic acid has also been reported (9).

Therefore, it is very important for the medical community to look for an alternative drug that is effective and efficient in the treatment of children with severe shigellosis.  Cefixime is the first third-generation cephalosporin that has been licensed for oral administration (10).

This drug has been used for several years and has good safety.

This drug has been used for several years and has good safety (11). For intestinal pathogens (such as Shigella, Escherichia coli, and Salmonella), cefixime has performed well in laboratory studies in America, Europe, and Japan (12-15).

Given the fact that dysentery has a high prevalence in all seasons of the year in Arak, there is no vaccination for prevention, and the use of antibiotics in its treatment is not without side effects and causes drug resistance in people and resistant strains. and also since the studies conducted in this field belong to other countries and several factors such as race, geographical area, etc. can affect the results of these studies. Considering that the pattern of resistance to antibiotics in each region is different from another region and considering that still in Iran and especially in the central province despite the high prevalence of dysentery, the treatment response of dysentery to different antibiotics has not been investigated and even though in the sources, both drugs azithromycin and cefixime have been mentioned in the treatment of children's dysentery, we decided to compare the effect of azithromycin and cefixime by conducting a study on children's dysentery in the city of Arak. In the treatment of children's dysentery, in order to reduce the additional cost and drug cost imposed on the patient by incorrect treatment, as well as the antibiotic resistance that occurs after incorrect treatment.

1-2- General

1-2-1- Dysentery

1-2-1-1- History

Dysentery is an infectious inflammatory bowel disease caused by microorganisms that invade the intestinal mucosa. This disease has been known as a long-standing scourge for humans, especially those who live under unsanitary conditions. The clinical definition of this infection is blood flow and low stool volume and rectal tenesmus. At the end of the 19th century, Entamoeba histolytica, which is an amoebic parasite, was recognized as the etiological agent of dysentery.

As the century passed, Bacillus dysenteriae was also introduced as another agent of dysentery. In the following decades, 3 more species of dysentery bacillus were identified through systematic epidemiological, physiological and serological investigations of epidemics. As a result, in 1950, the Shigella Commission gave the generic name Shigella in honor of Shiga, the Japanese bacteriologist who described the dysentery bacillus for the first time in 1898. rtl;"> In terms of bacteriology, Shigella is a member of the large family of intestinal bacteria, namely Enterobacteriaceae. More than 40 different serotypes of this bacterium have been identified in four main species or groups, including group A (Shigella dysentery), group B (Shigella flexeni), group C (Shigella boyidii) and group D (Shigella sonii).

Clinically, dysentery is a decisive clinical manifestation of shigylosis and consists of frequent bloody stools accompanied by mucus and pain. It is abdominal. Symptoms such as rectal tenesmus, fever, mild tenderness in the upper and left colon, and the presence of leukocytes indicate the presence of shigellosis, however, these symptoms are not completely specific to shigellosis.

Shigelose is usually a self-limiting disease, but retrospective analysis at the International Research Center for Diarrheal Diseases in Bangladesh (ICDD,B) showed that fatal infections in about 7 percent It occurs from patients.

The analysis of this information indicated that age (less than one year), change of consciousness (lethargy), abnormal reduction of serum protein and thrombocytopenia (less than 1 x 105 platelets/mm3) are the risk factors of death. Severe shigellosis (dysentery duration of more than 10 days) is often associated with growth retardation in children in developing countries. Hemolytic uremia syndrome (HUS) can occur as a complication of Shigella dysentery serotype 1 infection in affected patients.